How CABG Surgery evolved over time

2. EVOLUTION OF
CORONARY ARTERY BYPASS
GRAFT SURGERY

3. REVASCULARIZATION
PRE CABG ERA POST CABG ERA

4. PRE CABG ERA

5. EBERS PAPYRUS – Egyptian Medical Text 1550 BC.

6. LUCIUS ANNAEUS SENECA
• Ancient Rome.
• 4 BC – 65 AD.
• “Meditatio Mortis”
• Recorded his own anginal symptoms.

7. LEONARDO DA VINCI 1452 – 1519. ITALY / FRANCE.
Accurate drawings of Coronaries from an Ox Heart.

8. GABRIELE FALLOPPIO (1523-2562) ITALY.
• 16th Century Priest and
Anatomist.
• First to demonstrate
human coronary vessels by
Dissection.

10. EDWARD JENNER 1827 ENGLAND.
• Vaccine Pioneer.
• Probable
association of
angina and the
disease of
coronary arteries.

11. ALLAN BURNS 1809 SCOTLAND.
• Postulated that
angina pectoris
occurred as a result
of myocardial
ischemia and
actually observed a
thrombus in the
coronary artery.

12. ADAM HAMMER 1878 GERMANY
General Surgeon and Ophthalmologist.
ANGINA – INFARCTION.
Made the First Ever Diagnosis of Coronary
Thrombosis and Acute Myocardial Infarction in a
Living Patient

13. First Commercially Available Camera, built by Alphonse Giroux in 1839 French.

15. JAMES HERRICK 1912
• American Physician.
• Clinical Features of
Sudden Occlusion of
Coronary arteries due
to thrombosis was
Published.

16. OFF THE TRACK.
• Sympathetic Ganglionectomy of the Upper thoracic Ganglia– Francois
Franck.
• 1916 – Jonnesco – Bilateral Cervical Sympathectomy. (Decrease Rate,
Decrease Cardiac Work)
• 1901 – Kocher – Patient with angina became asymptomatic after Total
Thyroidectomy.

17. ALEXIS CARREL
• France.
• 1873 – 1944.
• Nobel Prize in Physiology or Medicine in 1912.
• Vascular Suturing Techniques.

18. ALEXIS CARREL
• 1910 – Attempted first Coronary Artery Bypass Graft.
• Experimented on Dogs. (Innominate – Distal Coronary)
• Free Carotid Artery between DTA and Left Coronary Artery.

19. WORLD WAR I (28 Jul 1914 – 11 Nov 1918)

20. MORE AND MORE HISTORY.
• 1930 – CLAUDE BECK – Cardiopericardiopexy and Poudrage.
• 1934, 1936 ROBERTSON AND GROSS – Venous Drainage of Heart back
to Myocardium.
• Beck I Operation – Ligate Coronary sinus – Collaterals.
• Beck II Operation – Vein between DTA and Coronary Sinus - 2 weeks –
Occlude coronary sinus to produce retrograde coronary blood flow.

21. WORLD WAR II (1 Sept 1939 – 2 Sept 1945)

22. ARTHUR VINEBERG 1903-1988
• Canadian.
• Implanted Cut End of Internal Thoracic Artery
into the Myocardium. (1946)

23. JOHN HEYSHAM GIBBON (1903-1973)
• HEART LUNG MACHINE.
• 1953

24. • 1954 – MURRAY – Direct CABG using Carotid, Axillary and ITA.
• 1956 – CHARLES BAILEY – First Closed Endarterectomy. Without CPB.
• 1957 – SABISTON – Performed Angiographically patent Anastomosis
between ITA and myocardial vessels.

25. WERNER THEODOR OTTO FORSSMANN
• The Nobel Prize in Physiology or
Medicine 1956

26. F MASON SONES (1918-1985)
• Father of Coronary Angiography.
• First Coronary Angio - October 30, 1958.
Cleveland Clinic.

27. ROBERT HANS GOETZ
• Frankfurt Germany
• May 2nd 1960
• First to perform an anastomosis of
the ITA to LAD

28. • Russian Cardiac Surgeon
• February 25 1964
• First CABG
VASILII IVANOVIC KOLESOV

29. MICHEL DABAGHI
• Micheal Ellis DeBakey
• Lebanese American.
• Among the earliest surgeons
to perform CABG.
• Saphenous vein to create an
aorta-coronary artery
bypass

30. RENÉ GERÓNIMO FAVALORO
• Argentina
• July 12, 1923 – July 29, 2000
• Advanced and Standardized CABG
technique.

31. POST CABG ERA

32. POST CABG ERA
• 1970 – Cardioplegia.
• By 1979 – 1,14,000 CABGs were done in United States alone.

33. Favaloro's work is fundamental to the history of graft selection.
He established the use of bilateral ITAs as superior to vein grafts.
Surgeons examined the use of other arterial grafts—splenic,
gastroepiploic mesenteric, subscapular and others—but none
matched the patency rates of ITA.

34. ALAIN CARPENTIER
In 1971, Carpentier introduced the use of
the radial artery, which was initially prone
to failure, but the development of
harvesting techniques in the following 20
years significantly improved patency.

35. 1982

36. • The introduction of PCI did not obsolesce CABG; rates of both procedures
continued to increase, but PCIs grew more rapidly.
• In the following decades, CABG was extensively studied and compared to
PCI.
• As of 2023, research comparing the two techniques is continuing.
• Meta-analysis published in 2023 suggests that CABG provides a
consistent survival benefit over PCI with drug-eluting stents (DES).

37. CORONARY ARTERY BYPASS
GRAFT SURGERY
TRIALS

38. HYPERLINK
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